need some help on this question

[jollyman069]

My pain specialist, who i have been going to for now 3 years, happens to be part of a group of drs. that travel to third world countries and voluenteer there services, which i think is great, I have had a bad flair up in pain this last 5 days or so, and i am on some very strong pain meds. well i call his office and the nurse told me to go to the local Er, and have them call the office and they would tell them it is okay to give me a shot. Well i go to the Er and the dr. there,refused to give me a shot. he said since i go to the pain dr they werewnt allowed to give me a shot, thet is even after his office gave them permission. I just dont understand why the Er dr. wouldnt help,i didnt ask for any more meds, i just needed some fast relieve, and we are a small community, wereas he is the only pain dr around so thee isnt anyone to cover for him Well thank god my pain is much better but i suffered for 3 or 4 days bad. Please let us knwo if any of you have ran into this proble, or any similar

[Tuckamore]

Hi Jolly,

I am so sorry this happened to you. Does your state have some law that prevents the ER from treating a PM Clinic patient for pain? That would be my first question to the ER. If the answer is "No" than they basically refused to provide you with any treatment. In my state that is a huge no-no.

I would report this if there are no laws prohibiting PM patients pain treatment. And I would do it asap. Unfortunately, in my opinion CP sufferers are discriminated against more frequently than not. My blood boils when ever this subject comes up. In my opinion we won't see a change in this unjust treatment any time soon.

Hang in there Jolly. At least we are all in this together, we have one another. I am grateful for you and every other member on this forum. You all make my "pain" life more bearable. Take Care, Tuck

[woodsprincess]

I went to the hospital 3 times when my doctor was supose to have called ahead . it was the most horrible experiance of my life. I later found out she called but did'nt give aproval for meds. I quit that doc. The hospital did,nt even know about their own pain management contract and demanded to see it. this did not help myself at the time. But I complained to the hospital about it later.I found a good doc. later.

[Amphitrite]

I'll answer your question because I have alot of knowlege in ER administration as my hubby works in our local ER.
Hospitals are tightining up their regulations within the ED amd also adding the gov regulations that they have to follow when medicating a patient.

For pain managment patients that come into the ER they really only treat the ones who's pain may be coming from another source such as abdominal pain and needing to rule out appendicis.
But the don't accept people who are in pain management to come and use them for convienence since that is how they see it. To the docs in the ED you should have been prepared if your doc was leaving town and they aren't an extention of your pain care..that's the way they see it.
Also a red flag is raised to them if someone is coming in looking just for a shot regardless of what the office has permitted someone to do because to the docs in the ER the people who are coming in needing pain killers are in really really bad shape and without a severe emergency they wonder if the person is just after a high.

Depending upon your state most hospitals have been
putting in tighter regulations within the past two  years that are making it more difficult for patients to recieve pain treatment without having a life threating or severe emergency.

But I don't blame the hospitals because it's not their job to oversee our pain treatment. That's our docs job and if a doc is going to be out of town for a while then they should be the ones making sure everything is all set incase of any problems that may arise while they're not around.
Well, of course the patient has to ask for what they think they may need also.

[jollyman069]

all that is ..is discrimantion to chronic pain suffefres.. our drs. god bless then cannot look into a glass ball to see whats happening in the future.. i could understand the Er not prescribing any meds i didnt ask for any oi have pain med s here at home.. i needed omething to stop or ease the sever pain that iwas in for the last 3 days.. i dint run up there on a whim.. iwas in sever pain for several days...i went through there office  i didnt go there without the rs office knowing it.. and here in maryland.. they have to treat your pain it is the LAW!!!  thaatnks Tuck i made a couple of phone calls

[Amphitrite]

Lawfully pain needs to be treated but it's up to the ED what pain they treat. That's why we have pain docs so they can treat people in chronic pain.
If the pain is not life threatning they don't have to treat it. Whether someone wants to see it as Discrimination ot not it's their call to make.

Some ER docs will treat chronic pain patients pain but those docs are few and far between. If they wree under legal rgulations to treat everybodies pain then anyone could walk in and say they are in pain and then get whatever they need. That leaves way too many oppertunities for the ED to start treating all the addicts in town. And having to legally.The ED's are not legally required to treat pain unless it's an emergency situation where the pain is either covering something more serious up or the pain is at a point where it is causing shock.

Docs don't have to look into a crystal ball. If they're leaving town for a month then it doesn't take a psychic to think that a patient may need soem extra help and make sure their patient is taken care of while they're gone. It's your docs responsibility not the ED's to make sure you have proper pain support.
Most docs have another doc that takes over for them or makes sure they're available if a patient needs them by phone. Pain docs can call scripts in using their ID number for short acting meds even when out of the country.

We can't expect every medical institution to take over our pain control because our docs are out of town. And legally they don't have to. Not for Chronic Pain patients anyway. Now if a man came in with his foot cut off and the ED didn't treat his pain then that's where the legalities start. The ED has no proof that a CP patients pain is real all they are going on is the patients word. And anyone can walk in and say they have pain and their doc has been given them medicine. The law full well knows that attaching legalities to ED means that they would have to treat the addicts who just want the drugs also.
The ED is so busy that it's not always possible to make phone calls to an office to get t the persons history and diagnosis.

I'd direct that anger twords changing gov regulations that have been put upon our docs not at the ED who is under no legalities to treat chronci pain patients outside of an emergency situation. By deeming that discrimination and trying to get it to change all you'd be doing is helping the addicts that ruin it for CP patients get what they need. The aim is to find a balance between helping us and stopping addicts but to do that it needs to start with pain docs not the ED. They have there won set of regulations and laws which don't include treating pain management patients in a non-emergency or life threatning situation.

But your energy into helping the pain docs than changing ED docs who are there to help save peoples lives not pick up our docs slack.
But with that said, if a flare is causing an emergency situation i.e someone passes out, goes into shock, etc then yes the ED docs need to treat that pain. But if someone walks in saying my docs away and I need some extra medicine they're not under any legal regulations saying they have to treat you. And that's not discrimination, it's being smart. The ED staff has no way of knowing who's pain is real and who's isn't. And if it's between calling our docs office to find out and saving a man in the next rooms life then I know I'd be glad they're gonna choose the latter because if my life is ever at risk then I'd want to know my doc isn't taking time away from my tx to find out if some guys pain is real or not so they can give him a shot of morphine.

My point...the ED is for emergencies not for follow up care or continuation of care when our docs are out of town. So many have started to see the ED as some sort of open all night clinic which is why they're so overpacked and you wait hours to be seen.

Take it for what this is. Just make sure you direct your anger in the right place and not on a department that exists to save lives. Direct it at changing government regulations instead so that the people who have no pain treatment and need it can start to get it.

[jollyman069]

i do not know what state you live in, but in Maryland it is state law that the hospitsl has to treat you for being in pain, Yes i understand if someone is in the next room and is dying sue the drs are going to take care of them first that is only common sense, and if you are in there seeking to get a scrip for something, i can see th dr not writing one..when you are in severe pain and i waited 3 days, before going to the ER and it is what my drs office told me to do!! We are a small community and my pain secialist is the only one in the area.. so i think mybe we are talking about two differnt things. I got my information about the hospital having to treat you for pain right from the hospital!!

[woodsprincess]

I am sure they just don't care and feel very powerfull in their position.It' so obvious.

[Tuckamore]

Hey Jollyman,

I worked in ER for some time and I still have friends that work in that department. In my state, in the hospitals I am aware of they DO treat CP patients in instances that you describe. Yes ER has become an over used department for every thing from sore throats to menstrual cramps but that is another story, another subject.

My sister also works in a hospital in another state. They often admit CP patients through the ER for pain control. The idea that severe CP is not an emergency is one held by some ED Dept's and staff. That opinion is changing, thankfully. True it is not life threatening, unless you consider the suicide rates of CP sufferers that can not obtain relief from their pain.

My motto; Severe chronic pain will not kill you, it only makes you wish you were dead. Again the street drugs and addicts can be thanked for much of the treatment we see in ER (ED) Departments and other medical facilities and providers.

I could write a book but I will leave it at that. My opinion remains Jolly, you were denied proper treatment. And I am sorry it happened to you. Indeed I am sorry when it happens to anyone.

Peace, Tuck

[Mollyrae]

To All:

I was rather amazed at some of the comments made here and I have to say I disagree with some of it. ER's are there for us no matter if your a CP or not, whether you have a PM Doc or not. I have a Doc that treats my pain and yes.. I signed an agreement; but that doesn't stop me from getting treated at an ER if I'm in need of one and I did need one just recently. As I was lying on a cot in the ER, they asked me what meds I take and I told them that I was taking Fentanyl and Oxycodone under contract by my Doc. After being assessed, I was given 1 shot of demoral every hour as needed. I was later admitted. ER's have a responsibility to treat you whether you have a contract or not. You know, my contract said that I could NOT receive any pain meds from any other Doctor EXCEPT that of an ER. I'm sure that most contracts say that. (Wisconsin residents anyway). So Jolly had every right to be treated in the ER. I guess the way I would have gone about it is...you should have told them that you were in more pain than usual and needed some relief and then left it up to the Doc's to give you something..Something of their choice. Never mention that you want a particular narcotic, that will make you look like your drug seeking. The Doc's cannot turn you away, I think it's a law that they have to treat you.  Well, I have added my two cents. Thanks,
Mollyrae

[jollyman069]

thats what i did, i told them that i was iun severe pain..went through my drs. office even got there permision to go there. they tol me too..i just told them i needed something for releif..hell torodal would have been a god send at that point

[Mollyrae]

That's too bad Jolly...I really would report them. If you have another Hospital you can go to then I would do that next time. I really hate Doctors that play God

[Tuckamore]

I too was surprised at some of the comments on this thread. I still think Jollyman was mistreated, well sorry, he wasn't even treated.

And Molly you are correct, in WI they DO TREAT CP patients in ER, even for pain control. I saw it when I worked there and I have had to go to ER myself. They also treat them in KY. My sister is also a nurse and she practices in that state. She says they admit many, many CP suffers through their ER for the sole purpose of pain control.

Jolly, you were not in error. You did the right thing, they did the wrong thing.

[Amphitrite]

My point is not that CP shouldn't be treated via the ED. My point is that the ED is under no legalalities which say they have to.
They're only purpose is to treat emergencies. Whatever else they'd like to deem an emergency is up to them.
Whether they treat CP at the ED in one state or another doesn't mean that it's legally required. It means they feel the person will benefit from their services.
But if a CP patient walks in saying, my docs out of town I need extra medicine then they're under no expectation to treat the person at all because 1) that person has a doc 2) they should have made sure they had the proper meds 3) the person is walking in themselves 4) the person doesn't appear to be in a physical emergency.

I think that many people in CP have reached a point of innability to see the other side of things. Take that offensivly or not. But I see alot of upset here about how addicts ruin things for CP patients but then I see alot of upset when someone can't get the treatment they think they're entitiled to despite what that would mean for what they're fighting against and fighting to have happen.
Put yoruself in the ER docs shoes. They have to go by what you say, not the proof of your pain. So the same would go for anyone scamming a doc. They should be treated also because how do the docs know they're pain isn't real?

Being brought in because the pain is too much to handle is a different story than walking in cause your doc is out of town. How does no one else see this?
When a CP patient is in the ED for pain it's because it's become so severe it's an emergency situation. That mean they can't walk, they can't think, they can't handle the stimulous around them on top of the pain. People who can walk themselves in, say they need extra medication cause they're doc is out of town...that's a situation that's not an emergency and something the ED 9 times out of 10 woldn't treat.
Not to mention that anyone walking in asking for pain meds specifically is under suspicion. Usually when a CP patients pain gets to the point the ED is needed a concern that there is something else going on or exacerbating the pain is there. Anyone going in and asking for pain meds is 9 times out of 10 going to get denied unless there is a more tham obvious need for them(i.e someones hand is hanging by a tenden off their arm)

You have to be realistic in advocacy. CP doesn't entitile anyone to recieve pain meds at any time they want or demand them. It's the docs responsibility to make sure they're patient is properly supplied when they're out of town for longer than a week or two.
And we can't have it both ways. We can't say that the addicts ruin everything for us and then say that we deserve treatment that makes it easy for addicts to infltrate narcotic pain treatment. There has to be a line somewhere. And you have to be able to see it from both sides to change anything. You have to have understanding for those that can't just treat every pain patient that walks through the door because by doing so in an ED enviorment they would only be increasing the number of addicts that continue to tighten up the regulations. There's a very fuzzy grey line that has to be there or none of us are going to end up being able to get treatment for our pain because the gov is going to become even more tight when they see how many addicts are walking out with narcotics and shots of dilaudid, who won't be paying their bills anyway.
Which brings me to another point that would be silly to get into. But the point being it isn't as simple as everyone makes it out to be. There's red tape, ethics, guildlines gov and inhouse, ect, ect.

But I guess this disagreement can go on forever so this is all I'll say. My advice is just to put yourselves in the other sides shoes because nothing can be changed, and nothing will change if someone can only see their side of things and what they think should happen. We all know there has to be a line somewhere of what were entitled to and what were not always entitiled to.

[Beargizmo]

my wife's former PM told her that if she EVER NEEDED PAIN MEDS...for what ever reason DO NOT GO TO THE ER, DO NOT CALL HER DENTIST do not go anywhere (including her PCP) for pain meds.  She was to call him FIRST.


Were she to go to the ER for an injection (for migraine for example) that would be acceptable...but she was not to obtain pain meds anywhere else. she made the mistake of calling her dentist with a tooth abcess (abscess) (having not studied the contract with a lawyer) and getting vicodin.  Next visit to the PM...they tested her..test came up negative for vicodin, percocet (which the PM had prescribed and she was out of) and positive for diluadid (?) which she had NEVER taken...come to find out, vicodin metabolizes into dilaudid after a few days and shows up that way on the test, and after getting a copy of the actual test..IT CLEARLY STATED THAT...but the PM ignorned it and booted her (described more below..)


the point is you SHOULD BE OK to get an injection, but clear it with your PM if possible or get a lawyer and a magnifying glass and read your contract.

Jim

[jollyman069]

what the one doesnt seem to be able to get through her head.. i was in SEVERE pain was that way for 3 days.. i didnt ask for any more pain meds have them at home.. wanted a shot for releif right then, so it would help the pain meds that iu am on work and i have said this twice now my pain specialist is the ONLY ONE in our area..so thewre is noone on call for him.. i called his office before i did anything.. so if you cant understand that stop putting up long post that we dont want to read

[kitty51]

JM,its a pity that there has to be so much **** that you have to go through just to get a bit of relief.We can go to our ER without any worry about not being treated,its a shame that such a highly populated country and all that it has,that a person suffering cant get simple pain relief.The  rules and regulations are B.S .Sorry to be mean about your counrty,but they spend trillions of dollars to fight wars,and they cant even take care of their own people.Hope that you got through it ok.

[sandee1818]

Amphitrite,
     It seems you want to put your thoughts and "expert opinions in and then expect everyone to agree with you and when they don't you get defensive and say well I am done.
Do you yourself  suffer from chronic pain because if you were a cp pt then you would KNOW just because a cp pt can walk in the ER and communicate and function that does not mean they are not in EXTREME pain. I have always been tol by every single PM Dr that if a pt is in extrme pain go the the ER or call 911. This is VERY common and most if not all pain management doctors tell their pts the same thing. The ER does HAVE to treat you! It is the law. The law does not stipulate in detail how they treat a cp pt but the ER does have to treat them.
Just because you consider yourself an expert does not make you one and I am sure your "hubby is an expert but he is not the one on here giving advice and opinions. You are.
You have to understand that each and every doctor is different in how they treat pain and often times the pt has proof they have pain. Just because the cp pt has a pain management doctor does not mean they do not have bouts where their pain becomes too much to handle. This is why the PM Dr will tell the pt to go to the ER for treatment.
The average chronic pain pt does have times when their meds do not work and they are in alot of pain that can not be controlled. It is no different than a heart pt going to the Er because they have chest pains even though they are on heart medications. Chronic pain is a disease!
As I was saying each Dr has their own way to handle pain and even Er Drs. They have a method they use to determine if the pt needs additional medications and they also know how to determine what they may give the pt. It sounds as if you think the Dr's in the Er's are incapable of doing their job. They are well experienced when it comes to determining if a pt is in pain or is simply out for drugs. I am not saying they are perfect in their decisions but they usually know the difference between a someone in great pain and someone wanting drugs.
The emegency room doctors are most likely the best judge of character when it comes to determing the difference between the addict and the pain pt as they see it often and they learn from it.
We can't sit back and say well I am in pain but hey it is not the ER's responsibility to treat me since I do have a PM Dr! That is ignorant. We chronic pain pts have a disease that needs treatment and it does not matter if it is the Er or our doctor that gives the reatment, all that does matter is that we do get the treatment.

[Beargizmo]

It's downright ridiculous is what it is.  Not to keep bringing up my wife's case but it was there in black and white on the report about vicoden metabolizing into dilaudid...and she had had a discussion with him about getting the vicodin from the dentist and while he was upset he told her NOT to do it again and he would not drop her..but based on the report which stated no percocet..of course it wouldn't show up..she had been out for 4 days before the test..he had advised her verbally that if needed she could take 1 more during the day OCCASIONALLY if needed..which she did..thus she ran out..so based on that and the report which he clearly didn't read..he booted her.  Meanwhile...my 20 year old daughter told her "Hey mom, if you want some percocet, I know where you can get some"...so do I..so does everybody..illegally.  But legitimatly need it and want to go about it legally?  No sir...can't do it...It is pure insanity.


Jim (sorry...this makes me so angry)

[sandee1818]

I am so sorry for your wifes pain. Has she found anyone to help her?

[Mollyrae]

Amphirite,

I am in amazement that you can say the things you do. After reading your latest comment, I have to wonder if your really a cp sufferer at all. You seem to have NO clue as to what we face from day to day. Just this am, I woke with so much pain, trying just to make it to the next room to sit...do you know that feeling? Hum..The pain meds I take are designed to work around the clock but this am the meds I am prescribed are just not enough. Ultimately, I had to lie back down til the X-tra breakthrough ( 1 more than prescribed ) started working. I'm sure that if you suffer with cp, you know what I'm talking about...right...
Just because a person is not screaming at the top of their lungs in pain doesn't mean they don't deserved to be treated. Everyone handles pain in a different way.
Hasen't your Doc told you to seek an ER if your pain level was too high for your meds to work? These are all reasons why I don't think you truley suffer with cp. You would certianly have a different outlook on things....trust me....
There is one more thing that bothers me and that is....Sometimes there are circumstances preventing the Doctor from being in the office to prescribe the required meds and the Doctor filling in for him/her will not feel comfortable writing the nessecary scrip...(this has happened to me) so the only alternative left is the ER. Thankfully the ER was understanding and had access to my medical records so they prescribed me enough to get me through until I could see my regular doc. So the story here is that yes, ER's can and do have the power/responsibility to medicate you................
I know I won't change you outlook on things but here is the outlook from a CP sufferer
Good day

[Tuckamore]

Thanks Sandee and Mollyrae,

You said it better than I could have. I was too angry. And poor Jolly was treated with disdain, disrespect and distrust. (the 3 D's)  Allowing a patient to suffer with severe pain when you can ease their pain is despicable. The ER Physician in my opinion did not act in a responsible humanitarian manner. Due to my anger yesterday I did not respond to Amphirite's soap box rant. According to her profile she is not a CP sufferer. She does not understand CP or what CP ppl face every day of their lives. Though I beleive she may be a nice enough individual she apparently does not have the wisdom to follow her own recommendation which is, QUOTE ".. put yourselves in the other sides shoes because nothing can be changed, and nothing will change if someone can only see their side of things and what they think should happen." END QUOTE

I do not know what position her husband functions in within the ED. I witnessed a co-worker that made rude & unkind comments (behind the pt's back) about most every person in pain that came through the ER doors. There was nothing the other staff could do to change his attitude, unfortunately due to his longevity (probably burn out) and the fact that he never voiced his disdain to the patients, they maintained his employment. So unfortunately and sad to say, these ppl with 'attitude' exist within out health care delivery system.

Thanks again Molly and Sandee. And to Jolly I'll say it again, I'm sorry this happened to such a dear heart as you. This should not happen to anyone, not even Amphirite. Peace, Tuck

[Beargizmo]

re: Sandee..No.  Her pcp doesn't "feel comfortable" prescribing pain meds, she is trying to get into a pain clinic here (In southern NH) but they're 3 months booked out and review one's case before taking it..there is one highly recommended in Boston...but that's 50 miles away and my wife, with only 1 eye, can't drive there which means me taking a day off...


I don't know what we're going to do yet.


Jim

[crazymae]

My, my, CP DOES make one cranky, huh?

[benzo1961]

i dont care what anyone says u had the right to be treated at that er. i dont care if u already have pain meds , if there not doing the job there suppose to help u in that darn hosp. u even had permission from ur dr but he should of handled it better. if this ever arises again u dont leave until u get the medical att u need.  prayers are with u. benzo1961    jennifer

[Boxerluver]

I know this post is older, but I was just reading through the posts and thought I'd kick in my 2 cents as this issue drives me crazy as I'm sure it does all us chronic pain patients.

First off, I know this is apple and oranges, but people in this country are innocent until proven guilty.  Why when we go to an ED, we are considered guilty(drug-seeking) until we can prove otherwise.  I can't tell you how much better my pain journey would have been if when I went to the ED I was treated as if I was TRULY in pain. One time they even tried to trick me, I was there for kidney stones and they gave me a shot of demerol and left another full syringe of demoral in the room on the counter. They said for later if I needed it and then left the room.  Then about 10 minutes later a different nurse came in and said here's your pain shot.  I told him I had already been given a shot and he tried multiple times to get me to take the shot, and the other full syringe was still on the counter. I refused and layed there. They ran no tests and eventually came in and said they were busy and needed me to leave. I told them I was still in pain and they said if I needed more pain meds they'd have to cath me which I knew was not true. I was so upset about that and we left. The next night after not peeing anything since before I had gone to the ED the day before, my doc ordered me stat to the ED. This time I got in with no wait, they found too many kidney stones to count and thank God the Doc I had the second night pulled no strings on me and gave me IV meds every hour.

Why was I treated like that!! That is not acceptable and we have every right to go to the ED with unmanaged and unanticipated pain. I think we have gotten used to accepting sub-standard care because we are afraid of losing the little bit of meds we do get because we know what our life is like without it. So if we all stand up for our rights maybe we can make a difference.

Now if I have to go to the ED, I know that I will get the care I need and deserve and my husband and I call the shots. I do not accept things that I don't need like being cathed to give a UA because people have put blood in their UA's to look like they have a kidney stone. We all need to know our medical rights and stand up for them.